Is great information good enough? Evidence from physicians as patients

Abstract

We place an upper bound on the degree to which policies aimed at improving the information deficiencies of patients may lead to greater adherence to clinical guidelines and recommended practices. To do so, we compare the degree of adherence attained by a group of patients that should have the best possible information on health care practices-i.e., physicians as patients-with that attained by a comparable group of non-physician patients, taking various steps to account for unobservable differences between the two groups. Our results suggest that physicians, at best, do only slightly better in adhering to both low- and high-value care guidelines than non-physicians.

Keywords: Clinical practice guidelines; High-value health care; Information disclosure; Low value health care; Patient adherence.

Figure 1

Degree of Over- or Under-utilization of Various Measures explained by Physician Effect—i.e., Information Effect—and by Other Factors (Sponsors Samples) Notes: data from the Military Health System Data Repository. The height of each bar represents the degree of over-utilization (for the case of cesarean delivery and preoperative testing prior to low-risk surgeries) and under-utilization (for the case of diabetes and cardiovascular care adherence and medication adherence for hypertension) represented in the respective samples, assessed with reference to non-physician patients. The black portion of this bar represents the degree of this over- or under-utilization that can be explained by the weaker information state of the non-physician patients. The height of the black portion is derived from the estimated physician effects from Tables 2–5.

Figure 2

Degree of Over- or Under-utilization of Various Measures explained by Physician Effect—i.e., Information Effect—and by Other Factors (Dependents Samples) Notes: data from the Military Health System Data Repository. The height of each bar represents the degree of over-utilization (for the case of cesarean delivery and preoperative testing prior to low-risk surgeries) and under-utilization (for the case of diabetes and cardiovascular care adherence, medication adherence for hypertension, and chicken pox vaccination) represented in the respective samples, assessed with reference to non-physician patients. The black portion of this bar represents the degree of this over- or under-utilization that can be explained by the weaker information state of the non-physician patients. The height of the black portion is derived from the estimated physician effects from Tables 2–6.